Hand Infection Treatment Kearney NE

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Diagnosis and Treatment of Hand Infections

In this article, hand surgeons from the Walter Reed National Military Medical Center in Washington, D.C. offer us a review of rare, but potentially disabling hand infections. They focus on two infections of the wrist, hand, or fingers: osteomyelitis and septic arthritis. Causes, type of bacteria involved, patient symptoms, diagnosis, and treatment are summarized for each condition. Complications with and without treatment are also presented.

Osteomyelitis is an infection of the bone or bone marrow that can affect the hand. The most common infecting bacteria are staph, strep, and e coli. Undiagnosed, delayed diagnosis, or untreated, any of these infectious agents can cause destruction of the joint. Loss of motion, impaired function, and eventual arthritis with pain, stiffness, and disability can occur. The disease process can get so bad, a person can lose the affected hand.

How does a person get osteomyelitis of the hand or wrist? There are three main mechanisms: 1) puncture wounds (e.g., human bites, thorns, fractures, and surgery), 2) spread from infection of nearby soft tissues, and 3) spread through the blood system from any other infection in the body.

The immune system sets up an inflammatory response and tries to wall off the infection. In the healthy child or adult, this reaction may be enough to take care of the problem. But malnutrition, smoking, medications that suppress the immune system, and cancer or other health problems can put the patient at a disadvantage for self-healing.

In the case of one particular bacteria (methicillin resistant Staphylococcus aureus or MRSA, pronounced "mersa"), even healthy people can be affected. Tissue invasion and severe bone destruction can occur quickly. That's why early diagnosis and immediate treatment is recommended for hand infections of this type.

How does the hand surgeon know a patient has an osteomyelitis-linked hand infection? There are usually visual signs (swelling, redness, warmth) and pain. The patient may have a fever with chills and fatigue. These flu-like symptoms are a red flag of systemic (system-wide) infection. Blood tests and imaging studies possibly including X-rays, bone scans, PET scans, MRIs, and other more advanced imaging aid in making the diagnosis.

Once it's clear what the surgeon is dealing with, then treatment begins. Antibiotics may be all that's needed if the problem is identified and caught early. But most of the time, surgery is needed to debride (clean out) the area. This surgical procedure is followed by a course of antibiotics as well.

It may be necessary to perform more than one debridement, a process called serial debridement. Serial debridement is done until the affected area is clear of infection. The whole process can take six weeks or more. If the infection has occurred around an implant (e.g., joint replacement or hardware used to repair a fracture), the implant may have to be removed before debridement and antibiot...

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